Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan.
Gastric Cancer. 2014;17(3):469-77. doi: 10.1007/s10120-013-0295-1. Epub 2013 Sep 15.
Pathological studies indicate papillary adenocarcinomas are more aggressive than tubular adenocarcinomas, but a definitive diagnosis is difficult using conventional endoscopy alone. The vessels within an epithelial circle (VEC) pattern, visualized using magnifying endoscopy with narrow-band imaging (ME-NBI), may be a feature of papillary adenocarcinoma. The aims of our study were to investigate whether the VEC pattern is useful in the preoperative diagnosis of papillary adenocarcinoma and to determine whether VEC-positive adenocarcinomas are more malignant than VEC-negative lesions.
From 395 consecutive early gastric cancers resected using the endoscopic submucosal dissection method, we analyzed 35 VEC-positive lesions and 70 VEC-negative control lesions matched for size and macroscopic type. We evaluated (1) the correlation between the incidence of VEC-positive cancers and the histological papillary structure and (2) differences in the incidence of coexisting undifferentiated carcinoma in VEC-positive and VEC-negative cancers and the incidence of submucosal and vascular invasion.
Histological papillary structure was seen in 94 % (33/35) of VEC-positive and 9 % (6/70) of VEC-negative cancers, a significant difference (P < 0.001). The incidence of coexisting undifferentiated carcinoma was 23 % (8/35) in VEC-positive and 3 % (2/70) in VEC-negative cancers (P = 0.002). The incidence of submucosal invasion by the carcinoma was 26 % (9/35) in VEC-positive cancers and 10 % (7/70) in VEC-negative cancers (P = 0.045).
The VEC pattern as visualized using ME-NBI is a promising preoperative diagnostic marker of papillary adenocarcinoma. Coexisting undifferentiated carcinoma and submucosal invasion were each seen in approximately one fourth of VEC-positive cancers.
病理研究表明，管状腺癌比乳头状腺癌更具侵袭性，但仅使用传统内镜进行明确诊断较为困难。使用窄带成像放大内镜观察到的上皮环状血管（VEC）模式可能是乳头状腺癌的特征之一。本研究旨在探讨 VEC 模式是否有助于术前诊断乳头状腺癌，以及 VEC 阳性腺癌是否比 VEC 阴性病变更具恶性。
从 395 例连续接受内镜黏膜下剥离术切除的早期胃癌患者中，我们分析了 35 例 VEC 阳性病变和 70 例大小和大体类型相匹配的 VEC 阴性对照病变。我们评估了（1）VEC 阳性癌症的发生率与组织学乳头状结构之间的相关性，以及（2）VEC 阳性和 VEC 阴性癌症中同时存在未分化癌的发生率以及黏膜下和血管侵犯的发生率之间的差异。
VEC 阳性病变中可见组织学乳头状结构的占 94%（33/35），而 VEC 阴性病变中仅占 9%（6/70），差异具有统计学意义（P<0.001）。VEC 阳性病变中同时存在未分化癌的发生率为 23%（8/35），而 VEC 阴性病变中为 3%（2/70），差异具有统计学意义（P=0.002）。VEC 阳性病变中黏膜下侵犯的发生率为 26%（9/35），而 VEC 阴性病变中为 10%（7/70），差异具有统计学意义（P=0.045）。
使用 ME-NBI 观察到的 VEC 模式是一种有前途的乳头状腺癌术前诊断标志物。大约四分之一的 VEC 阳性病变中存在同时存在未分化癌和黏膜下侵犯。
